Uterine Fibroid Embolization

Fibroids are benign tumors of the uterus (womb).  They do not possess cancerous tendencies, so they are not life threatening. Fibroids are highly common and around half of the women in this world get affected with them at some stage of their lives. It is seen that in most of the women with fibroids, symptoms do not even appear at all. They may stay unaware of the presence of fibroids in their body.But some may face huge suffering because of them.Fibroids are made of muscle and are highly vascular i.e. well supplied with blood. Although the causes of fibroid are unknown, the hormones play a huge role in their growth. It is seen that during a woman’s mid life when the estrogen levels are at peak, they grow faster. They usually affect the women in the 30-35 years age group and are rarely seen in teenage girls. After the menopause, the fibroids tend to shrink.

What symptoms can it cause?

• Increased bleeding / passage of clots during menstrual periods.
• Increased bleeding resulting in anemia.
• Chronic lower abdominal pain.
• Increased pain during menstruation.
• Painful intercourse.
• Frequent urination.
• Difficulty in emptying urinary bladder.
• Constipation
• Reproductive problems and/or complications during pregnancy or labor

What are the types of fibroids?

Fibroids can be of four types depending on their location.

• sub-serosal (outside of the womb under the mucosa)
• intra-mural (within the uterus wall)
• sub-mucosal (inside of the uterus under the mucosa)
• cervical (arising from the cervix (the neck of the womb) itself)

Infertility and Problems with Pregnancy?

In most of the cases, fibroids do not interfere with the pregnancy or ability to carry pregnancy. But some of them may lead to an uncomfortable pregnancy. They can even result in difficulty in conceiving or miscarrige in some cases. This is logical as an abnormal lump in the uterus can easily be imagined blocking the fallopian tube preventing the egg travelling from the ovary to the uterus.  Pregnancy loss or interference with embryo growth may occur due to the fibroids within the womb lining. Occasionally, few fibroids may become non-vital because of lost blood supply during pregnancy resulting in severe pain, misscarriage or premature delivery.

Large fibroids may obstruct a baby’s passage to move out during birth leading to difficult delivery. In such cases, a caesarean section surgery may become necessary. Fibroids may increase the risk of heavy bleeding after birth which may later require some kind of intervention to stop.

What are the available treatment options for uterine fibroids?

1. Hormonal drugs (cannot be taken for long duration since it has its own side effects)
2. Surgical –
   1. hysterectomy – removing uterus.
   2. Myomectomy – surgical removal of the fibroids.
3. Non-surgical – Uterine fibroid embolization (UFE)

What is Uterine fibroid embolization (UFE) and how is it done?

Fibroids have a rich blood supply from the uterine arteries. If these arteries which are supplying the fibroids are blocked, eventually fibroids shrink and symptoms will disappear.

After giving local anesthesia in the hand or leg, through a small pin hole sized access in the artery of the wrist or in the groin, small angiographic catheters are inserted and uterine arteries are entered. Through this small particle called PVA particles are injected which results in shrinkage of the fibroids. This procedure is done inside a cath lab by an interventional radiologist and will only take an average of 45 min – 1 hour depending on the anatomy and is particularly effective for fibroids less than 12 cm size.

What are the advantages of UFE when compared to surgical methods?

1. Uterus is preserved.
2. No scars in the uterus (scars in uterus can lead to complications in subsequent delivery).
3. No need for general anesthesia.
4. Can leave the hospital in 24 hours.
5. Can return to normal activities as soon as they go home.
6. No need for prolonged bed stays.
7. Does not interfere with hormonal functions, since ovarian function is not impaired
8. Less rate of complications as compared to surgery .
9. Normal periods will be preserved in menstruating ladies.
10. Avoids the possibilities of developing obesity, high blood pressure, depression and early ovarian atrophy after hysterectomy.